Just curious, but what happens when you run across a prescription that would be extremely dangerous to dispense as written, you contact the doctor to point this out, and the doctor's reply is to dispense as written?
Hypothetical example: A certain narcotic is available in dosages of X, 2X, and 4X milligrams per tablet. Each tablet also contains approximately 300 milligrams of acetaminophen, regardless of the narcotic dosage. A prescription comes in for this narcotic in dosage X, to be taken as 4 tablets 4 times per day. This would result in the patient taking FAR more than the safe daily dosage of acetaminophen per day.
Since this pill would be prescribed for the narcotic content (as the other active ingredient is OTC), the doctor might not be aware of the danger. Pharmacist calls the doctor, informs them of the problem, and suggests that the prescription be changed to dosage 4X of the narcotic to be taken as 1 tablet 4 times per day. This would give the same narcotic dosage, but 1/4 the acetaminophen. Doctor refuses to make the change.
Obviously, a pharmacist can't make the change on their own. Do you dispense as written, even though this would result in a (probably) lethal dose of the acetaminophen? Do you simply return the prescription to the patient unfilled, explaining the problem, and hope the next pharmacist also catches the problem, or do you, before returning the unfilled prescription, write on it "(pharmacy name) refused to fill - as written, has unsafe dosage of acetaminophen"? Note that you're not questioning the dosage of the narcotic.
As an aside, I can see TWO reasons (neither is valid) for the doctor to insist on dispensing as written:
1) Trying to kill the patient.
2) Doctor knows (or suspects) the patient is reselling the pills. By having dosage X instead of 4X, the patient/pusher has more flexibility in selling to their clients.
Hypothetical example: A certain narcotic is available in dosages of X, 2X, and 4X milligrams per tablet. Each tablet also contains approximately 300 milligrams of acetaminophen, regardless of the narcotic dosage. A prescription comes in for this narcotic in dosage X, to be taken as 4 tablets 4 times per day. This would result in the patient taking FAR more than the safe daily dosage of acetaminophen per day.
Since this pill would be prescribed for the narcotic content (as the other active ingredient is OTC), the doctor might not be aware of the danger. Pharmacist calls the doctor, informs them of the problem, and suggests that the prescription be changed to dosage 4X of the narcotic to be taken as 1 tablet 4 times per day. This would give the same narcotic dosage, but 1/4 the acetaminophen. Doctor refuses to make the change.
Obviously, a pharmacist can't make the change on their own. Do you dispense as written, even though this would result in a (probably) lethal dose of the acetaminophen? Do you simply return the prescription to the patient unfilled, explaining the problem, and hope the next pharmacist also catches the problem, or do you, before returning the unfilled prescription, write on it "(pharmacy name) refused to fill - as written, has unsafe dosage of acetaminophen"? Note that you're not questioning the dosage of the narcotic.
As an aside, I can see TWO reasons (neither is valid) for the doctor to insist on dispensing as written:
1) Trying to kill the patient.
2) Doctor knows (or suspects) the patient is reselling the pills. By having dosage X instead of 4X, the patient/pusher has more flexibility in selling to their clients.
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